Obamacare: 5 states to watch

States entered 2012 not knowing whether President Barack Obama’s health care law would survive. They enter 2013 facing the reality of impending deadlines and tough choices that can’t be put off much longer.

Even states that have turned down the chance to build their own exchanges — about 30 in all — have about six weeks to decide whether they want to partner with the feds on key functions. Although states don’t face a deadline to say whether they’ll expand their Medicaid programs under the Affordable Care Act, the clock is definitely ticking.

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In some states, their paths are already set. In most, though, state officials will wrestle with questions about the future of their insurance markets and crunch the numbers on the ACA’s Medicaid expansion — all as the Obama administration continues to pump out guidance and rules to move implementation of the health law full speed ahead.

Though governors may have come out strongly one way or another on implementation, most of them will have to face their first legislative sessions since the Supreme Court upheld the ACA. And even if states aren’t expanding Medicaid or setting up their own exchanges, they’ll have to confront possible changes to state laws to align with ACA requirements — or risk having the feds step in to regulate their insurance markets like never before.

Here are five of the more interesting states to watch on ACA implementation in 2013:

Florida

Sure, Gov. Rick Scott said some nice things after the election about wanting to work with the Department of Health and Human Services on ways to implement the law in his state, which was the leading plaintiff in the Supreme Court challenge. But when push comes to shove, will Florida do a 180 and make way for Obamacare?

Scott is scheduled to meet with HHS Secretary Kathleen Sebelius next week, and the state Senate recently formed a committee dedicated to studying the state’s ACA options. If Florida decides to eventually run its own exchange — 2014 seems to be out of the picture — state officials have identified two programs, Florida Health Choices and Florida Healthy Kids, as existing structures that could support the new insurance marketplace.

It’s also hard to imagine Florida expanding its Medicaid program after fighting so hard against the expansion before the Supreme Court. Still, Florida is waiting on the Centers for Medicare & Medicaid Services to rule on the state’s request to significantly expand managed care in its existing Medicaid program, so maybe there’s some room for negotiation.

Idaho

Gov. Butch Otter was the only one of his Republican colleagues to greenlight a state-based exchange after the election — the two other Republican governors moving ahead on a state-run exchange had made up their minds long before. But the Republican-run state Legislature could still prevent that from ever happening.

State lawmakers in 2012 rejected a $20 million HHS grant that would have allowed Idaho to plan for an exchange. The majority leader in the state House of Representatives is urging Otter to let the feds set up Idaho’s exchange before rushing into anything.

Otter’s still undecided on the Medicaid expansion, which could potentially cover an additional 108,000 people. An advisory panel he set up in the summer recommended that Idaho expand the Medicaid program, as long as the state could enact major reforms to go with it.

Readers' Comments (2)

Don't set up the exchanges and the federal government will do it for you. And they will run them. And you won't have any say in what is happening in your state. So if Obamacare is a plus, you won't be able to take credit for it. There's the risk.

Of course what you're supposed to do as an elected official is actually serve your constituents...